Provider Demographics
NPI:1639959257
Name:FOOTE, NICOLE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:FOOTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 OCONNELL RD
Mailing Address - Street 2:
Mailing Address - City:CONSTABLE
Mailing Address - State:NY
Mailing Address - Zip Code:12926-2500
Mailing Address - Country:US
Mailing Address - Phone:518-319-2746
Mailing Address - Fax:
Practice Address - Street 1:42 RIVER ST
Practice Address - Street 2:
Practice Address - City:CHATEAUGAY
Practice Address - State:NY
Practice Address - Zip Code:12920-2002
Practice Address - Country:US
Practice Address - Phone:518-497-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264525164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse